Last update: Feb. 12, 2019
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Among the many existing Candida species, the one that most frequently affects humans is Candida albicans, which is a commensal frequently found in the mouth, gastrointestinal tract, vagina and skin and only occasionally causes disease.
It can be found in the nipple/areola of more than a third of healthy, asymptomatic mothers (Boix 2017, Hanna 2011, Francis 2004) and some associate it with the early use of feeding bottles (Morrill 2005).
Oligosaccharides, lysozyme and dermcidin in breastmilk inhibit the growth and adhesion of candida, protecting the intestine of the infant, especially premature infants (Chow 2016, Gonia 2015, Vudhichamnong 1982).
The deep, burning pain of the breast and nipple during breastfeeding has been classically associated but without laboratory tests, - culture, PCR (Hanna 2011, Moorhead 2011, Hoover 1999, Bodley 1997), with ductal infection or candida mastitis (Lawrence 2016 p 468, ABM 2014, Brent 2001), this association being questioned (ABM 2014, Carmichael 2002) since when milk samples are taken from women with this type of pain, the cultures can be negative, or candida can also grow on the breasts of healthy women, or Staphylococcus aureus can also appear (Witt 2014, Amir 2013, Betzold 2012, Hale 2009, Eglas 2006, Graves 2003, Thomassen 1998).
It should also rule out other possible diagnoses as bad latching, vasospasm or Raynaud’s phenomenon of the nipple, dermatosis of the nipple, depressive symptoms, functional pain or milk overproduction (Berens 2016).
Candida was found in a small proportion of cases of deep pain, but also in asymptomatic women (Amir 2013, Betzold 2012).
Candida was found in 25% of women with deep breast pain, but there were no significant differences in symptoms and evolution depending on the positivity or negativity of the culture (Kaski 2018).
One study found no significant differences in the proportion of candida found (by culture or CRP) in healthy women and in women with symptoms of deep breast pain (Mutschlechner 2016), while others did: 54% in cases of pain, compared with 36% in women without pain (Amir 2013) or 30% versus 8% respectively (Andrews 2007).
The diagnosis of internal or ductal candidiasis, or candida mastitis is therefore controversial, but there may be infection of the nipple/areola, or oral, cutaneous or vaginal infection in the mother.
Given that the mother and the infant can infect each other, both should be treated (Barrett 2013), without forgetting the mother's partner.
Neither the maternal disease nor the required treatments are incompatible with breastfeeding (Kaplan 2015).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.
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